Healthcare Provider Details

I. General information

NPI: 1881777134
Provider Name (Legal Business Name): REHAB AND GERIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2935 COLONIAL DR
COLUMBIA SC
29203-6811
US

IV. Provider business mailing address

PO BOX 11671
COLUMBIA SC
29211-1671
US

V. Phone/Fax

Practice location:
  • Phone: 803-401-1372
  • Fax: 803-401-1178
Mailing address:
  • Phone: 803-401-1372
  • Fax: 803-401-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM DANIEL WESTERKAM
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 803-401-1404